Provider Demographics
NPI:1073778601
Name:VU, KATHY (OD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 N 51ST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2809
Mailing Address - Country:US
Mailing Address - Phone:623-414-6476
Mailing Address - Fax:
Practice Address - Street 1:11851 N 51ST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2809
Practice Address - Country:US
Practice Address - Phone:623-414-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist